Provider Demographics
NPI:1447976055
Name:PACIFIC ISLANDS NUTRITION AND HEALTH LLC
Entity type:Organization
Organization Name:PACIFIC ISLANDS NUTRITION AND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DELOS REYES
Authorized Official - Last Name:WILLSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:670-484-4300
Mailing Address - Street 1:PMB 532, BOX 10000
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-484-4300
Mailing Address - Fax:
Practice Address - Street 1:GREEN HILL ESTATES
Practice Address - Street 2:MT. TOPOCHAU
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-494-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty